Table 2 Examples of FIC trainee related research influencing policy and programs

Uganda

Infant prophylaxis during intrapartum and breastfeeding periods

During the late 1990s and early 2000s a series of publications by a FIC trainee and colleagues [14–16] established the effectiveness of nevirapine in protecting infants from contracting HIV during the intrapartum period and breast feeding. One of these papers [15] was described as “an historic breakthrough” in a letter to the Lancet [17]. Recently the team has studied the effects of providing a single dose of nevirapine versus administering it for six months and this, along with evidence from elsewhere has also influenced global guidance.

Male circumcision to prevent HIV/AIDS

Two randomized control trials involving multiple FIC trainees that examined the effects of male circumcision on HIV transmission [18], have been widely referenced (the 2007 article has been cited nearly 900 times). This program of research has changed international and national policies.

Community-based TB programs

Uganda has been seeking to strengthen its TB programs through the use of community based directly observed therapy (DOTS). An early study in one district argued for the feasibility and effectiveness of such a program [19], and subsequently the Ministry of Health adopted community-based DOTS. Recent small scale studies also by FIC trainees explored the use of lay health workers in such contexts [20].

TB diagnosis

Studies by faculty at Case Western, one of the US partners supported by FIC, in which a Ugandan FIC trainee played a critical part, reviewed the usefulness of the 3^rd sputum in the diagnosis of smear-positive TB [21]. This study contributed to changes in international recommendations by the World Health Organization in 2007, so that only 2 rather than 3 sputum smears are taken for the diagnosis of TB.

Alcohol use during pregnancy

Research by a FIC trainee on the prevalence of alcohol use in pregnancy raised concerns about the number of women drinking alcohol immediately before and during pregnancy [22]. The study has led to a campaign by Mulago hospital to reduce alcohol use during pregnancy and the MOH is also seeking to raise awareness about this issue. A follow-up study examining the effects of enforcing alcohol labeling was conducted, and at the time of the research, discussions were underway about the policy implications of the findings.

Kenya

Pediatric HIV

Research by FIC trainees and colleagues on infant feeding, breastfeeding and HIV transmission [23–31] contributed significantly to WHO guidelines on breastfeeding. A follow-up study coordinated by the WHO and known as the “Kesho Bora” study, was a multi-country study of antiretrovirals to prevent mother-to-child transmission and this again helped to change policy internationally with guidelines developed for HAART for the mother and extended prophylaxis for the baby. One of the same FIC trainees also served on the WHO committee developing guidelines in this area.

Treatment of herpes in discordant couples

Research by a FIC trainee and colleagues at the University of Washington (also supported by FIC), with support from the Bill and Melinda Gates Foundation examined the effectiveness of acyclovir in reducing genital ulcers, and thus slowing the transmission of HIV [32–34]. The study demonstrated that while acyclovir was effective in reducing genital ulcers it did not slow HIV transmission. While it is difficult to demonstrate the direct translation of this finding into policy (as it is a ‘negative’ finding) several respondents cited this study as being of considerable policy significance.

Syndromic management of STIs

Studies by a FIC trainee and colleagues at the University of Manitoba helped demonstrate that health workers could undertake syndromic management of STIs [35–38], although other work by FIC trainees and collaborators [39] demonstrated the poor quality of care often provided.